Promoting Adherence to Treatment in Schizophrenia

描述(由申请人提供)：这份R01拨款提案是对PA-00-016“关于坚持精神障碍干预措施的研究”的回应的修订版。该项目(A)在公共精神卫生环境中使用随机对照设计评估旨在促进墨西哥裔美国精神分裂症患者治疗依从性的文化适应的、基于家庭的干预措施，并(B)测试有关阿杰岑的计划行为理论(TPB)是否适用于治疗依从性研究的假设，该理论是干预措施关键结构的概念基础。之所以选择这个概念模型进行研究，是因为它对主观规范和感知行为控制的重要作用的强调与研究人群和拟议的干预措施高度相关。墨西哥裔美国精神分裂症患者及其家人将在精神科住院期间进入这项研究，并在出院后进行为期两年的跟踪调查。受试者将被随机分配到：1)多个家庭小组的一年，强调对遵守的态度、主观规范以及自我感觉和实际遵守技能的重要性，并添加到持续的常规门诊护理中；2)在常规门诊护理的基础上增加一年的标准多家庭小组；或3)仅常规门诊护理(每月药物治疗疗程和临床需要的额外服务)。将在基线和每四个月对两年的实际依从性行为(使用将行为测量与多个告密者相结合的多维方法)以及基于项目理论模型的假定中介因素进行评估：坚持治疗的意图；用于实现这一意图的决策过程；感知的主观规范(即对其亲属关于治疗依从性的偏好的感知；获得、维持和利用治疗依从性技能的真实和感知的能力；对疾病及其治疗的态度；精神病理学水平和其他重要结果(例如，社会功能、生活质量、复发和再住院率)。主要亲属将在同一时间框架内接受评估，以确定他们对他们如何以及为什么影响患者行为的理解；他们对患有精神疾病的亲属的态度；他们对精神分裂症的了解和看法；他们在治疗过程中的合作参与者角色；以及他们对亲属的治疗和康复的期望。这一结果将促进对墨西哥和美国精神分裂症患者坚持治疗的影响因素的理解，如果治疗有效，将为改善这一人群的治疗坚持提供新的工具。

DESCRIPTION (provided by applicant): This R01 grant proposal is a revised version of a response to PA-00-016 "Research on Adherence to Interventions for Mental Disorders." The project (a) evaluates a culturally adapted, family-based intervention designed to promote treatment adherence among Mexican-Americans with schizophrenia using a randomized, controlled design in a public mental health setting, and (b) tests hypotheses about the applicability of Ajzen's theory of planned behavior (TPB), the conceptual foundation for the intervention's key constructs, to the study of treatment adherence. This conceptual model was selected for study because its emphases on the important roles of subjective norms and perceived behavior control are highly germane to the study population and to the proposed intervention. Mexican-Americans with schizophrenia and their families will be entered into the study during a psychiatric hospitalization and followed after discharge for two years. Subjects will be randomly assigned to either: 1) one year of multiple family groups that emphasize the importance of attitudes towards adherence, subjective norms, and self-perceived and actual adherence skills in maintaining adherence, added to ongoing customary outpatient care; 2) one year of standard multiple family groups added to customary outpatient care; or 3) customary outpatient care only (monthly pharmacotherapy sessions and additional services as clinically needed). Evaluations will be made at baseline and every four months for two years of actual adherence behaviors (using a multi-dimensional approach that integrates behavioral measures with multiple informants), and of the postulated mediating factors based .on the project's theoretical model: intentions to adhere to treatment; decision-making processes used to arrive at this intention; perceived subjective norms (i.e., perceptions regarding their relatives' preferences regarding treatment adherence; real and perceived ability to acquire, maintain, and utilize treatment adherence skills; attitudes towards the illness and its treatment; levels of psychopathology, and other important outcomes (e.g., social functioning, quality of life, relapse and rehospitalization rates). Key relatives will be assessed during those same time frames to determine their understanding of how and why they influence the patient's actions; their attitudes towards their mentally ill relative; their knowledge and views of schizophrenia; their roles as collaborating participants in the treatment process; and their expectations with regard to their relative's treatment and recovery. The results will advance the understanding of the factors that affect adherence to treatment for Mexican, Americans with schizophrenia, and, if the treatment were effective, would add a new tool for improving treatment adherence in this population.